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25 September 12 Tips for Reducing Pain with Insulin Injections

For those of you with diabetes who take insulin, take heart! While insulin injections can sometimes cause pain or discomfort, there are tips for reducing or eliminating pain. Most of the tips reported here are taken from a presentation given by Stacey Seggelke, MS, RN, CNS, CDE, BC-ADM at the Rocky Mountain Metabolic Syndrome Symposium on May 14, 2010.

Alcohol

After swabbing your injection site with alcohol, wait for it to DRY before injecting insulin. Alcohol can feel like a burning sensation if it gets pushed in along with the insulin.

Temperature

Injecting insulin that is cold will hurt more than if it is at room temperature. Remove your unopened insulin from the refrigerator long enough in advance before use so that it is at room temperature when you need to use it. Once your vial or pen is in use, you can store it at room temperature (59F – 86F). Insulin vials can be stored at room temperature for up to 1 month. Most rapid-acting or long acting insulin pens can be stored for up to 28 days at room temperature. However, premixed insulin or intermediate N or NPH pens should be stored for up to only 10 – 14 days. Never guess at your insulin's room temperature storage guidelines - always check the information provided with your insulin for number of days it can be used at room temperature. Unopened insulin can be stored in the refrigerator (36F-46F) up until the expiration date. However, once the expiration date is reached, do not use the insulin – discard it.

Dose

Higher doses can hurt more than lower doses of insulin. For those of you with Type 2 diabetes, losing weight and regular exercise could improve your insulin sensitivity enough so that less insulin is needed to control your diabetes. And for folks with Type 1 or Type 2 diabetes, good carb counting skills, appropriate use of and technique with insulin, appropriate type of insulin, might also result in lower dosing required to control blood glucose.

Injection Speed

Inject needle with a confidant, efficient stroke vs. with a very slow and tentative stroke. To ensure complete delivery of your insulin dose, be sure to push plunger down completely and hold for about 10 seconds before removing needle. If you need to pinch the skin for injections, then release the pinch before you remove the needle. After removal of the needle, hold your finger over the injection site for about 10 seconds to help prevent leakage.

Needles

Do not reuse needles. Use a new needle for every injection. Needles used repeatedly get bent and/or dull and this can cause more pain. The same is true for the lancets you use for blood glucose testing.

Use an appropriate needle length & gauge. Use a short enough needle so that you are injecting into subcutaneous fat instead of into your muscle. Higher gauge numbers mean thinner needles. If you are still using "Original" needles (1/2 inch or 12.7 mm long and a gauge or thickness of 28G-30G), then it is time to consider shorter and thinner needle options. Short needles (5/16 inch or 8 mm and 31G) are now standard but Mini needles (1/4 inch or 6 mm with 31G down to 4 mm with 32G) are the most comfortable and will still allow for injection into the subcutaneous fat layer, regardless of body size. Injecting with long needles increases the risk of injecting too deeply and hitting the muscle layer which causes pain.

Injection Site

Rotate your site of injection – that is, avoid injecting into the same exact injection site you last used. This will help avoid scarring and reduce skin irritation and pain. This does not mean rotating body area sites (e.g. going from abdomen to thigh). Instead, just move to another area within the same body area location. The most rapid delivery of subcutaneously injected insulin occurs at the abdomen. Injecting in the arms or thighs is slower, while injecting into the buttocks is the slowest delivery. Generally, the abdomen, excluding the 1-2 inches surrounding the belly button, is the primary body area for insulin injection for most folks.

Be sure to share your concerns about insulin use with your doctor and diabetes educator. Demonstrating insulin injection technique at visits will help you improve your technique for maximal effectiveness with minimal discomfort.